Safe and effective of airway clearance techniques for patients with severe respiratory failure

• Project/Area Number: 16K20746
• Research Category: Grant-in-Aid for Young Scientists (B)
• Allocation Type: Multi-year Fund
• Research Field: Clinical nursing
• Research Institution: Ibaraki Christian University (2018-2019); University of Tsukuba (2016-2017)
• Principal Investigator: Sakuramto Hideaki 茨城キリスト教大学, 看護学部, 准教授 (20755590)
• Project Period (FY): 2016-04-01 – 2020-03-31
• Project Status: Completed (Fiscal Year 2019)
• Budget Amount: ¥3,380,000 (Direct Cost: ¥2,600,000、Indirect Cost: ¥780,000); Fiscal Year 2018: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000); Fiscal Year 2017: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000); Fiscal Year 2016: ¥1,300,000 (Direct Cost: ¥1,000,000、Indirect Cost: ¥300,000)
• Keywords: 人工呼吸 / 気道クリアランス / 気管吸引 / 胸郭圧迫法 / サクション / 用手的胸郭圧迫 / クリティカルケア / 気管吸引圧 / 閉鎖式吸引 / せん妄 / 水分出納バランス / 気道クリアランス方法 / 重症呼吸不全患者 / クリティカルケア看護学 / 気道クリアランス手技

Outline of Final Research Achievements

Closed suction was performed on rabbits with severe lung injury, and it was found that suction pressure of about 300 mmHg had little effect on oxygenation compared with suction pressure recommended by the guidelines so far. In the prospective observational study, closed suctioning was deeper and higher suction pressure than recommended by the guideline, but there were few complications and severe adverse events did not occur. Hard and brief manual rib cage compression combined with closed suctioning was safe and led to improvement of mucus clearance; however, no effectiveness was confirmed with regard to oxygenation and ventilation. Airway clearance requires some patient cooperation and understanding. We performed a risk factor analysis on delirium and found that excess fluid was one of the risks.

Academic Significance and Societal Importance of the Research Achievements

ガイドラインでは吸引圧を150mmHgまでとしているが、これは古典的な開放式吸引システムを使用によるデータに基づいている。現在ICUでは、閉鎖式吸引と呼ばれる気管吸引システムが主である。このシステムでは人工呼吸器からの送気、圧サポートにより肺虚脱が起こりにくいとされる。従って閉鎖式吸引では、ガイドライン推奨吸引圧より高い圧で気管吸引を実施しても合併症は起こりにくいことが考えられる。この仮説に基づき動物実験、観察研究を実施し、ガイドライン推奨よりも高圧でも大きな合併症が観察されないことを明らかにした。また気道クリアランス法に関してデータの少ない胸郭圧迫法の効果に関しても明らかにしている。

Research Products

• [Journal Article] Effects of Manual Rib Cage Compressions on Mucus Clearance in Mechanically Ventilated Pigs (2020)
  • Author(s): Ouchi Akira、Sakuramoto Hideaki、Unoki Takeshi、Yoshino Yasuyo、Hosino Haruhiko、Koyama Yasuaki、Enomoto Yuki、Shimojo Nobutake、Mizutani Taro、Inoue Yoshiaki
  • Journal Title: Respiratory Care Volume: - Issue: 8 Pages: 07249-07249
  • DOI: 10.4187/respcare.07249
  • Peer Reviewed
• [Journal Article] Association between fluid overload and delirium/coma in mechanically ventilated patients (2020)
  • Author(s): Akira Ouchi Hideaki Sakuramoto Haruhiko Hoshino Yujiro Matsuishi Tatsuya Sakaguchi Yuki Enomoto Tetsuya Hoshino Nobutake Shimojo Yoshiaki Inoue
  • Journal Title: acute medical & surgery Volume: 7 Issue: 1
  • DOI: 10.1002/ams2.508
  • Peer Reviewed / Open Access
• [Presentation] Effectiveness of the Visually Enlarged Numerical Rating Scale for Pain Management (2020)
  • Author(s): Akira Ohuchi, Hideaki Sakuramoto
  • Organizer: American Association of Critical Care Nureses
  • Int'l Joint Research
• [Presentation] 看護師の吸引手技に関する実態調査 (2019)
  • Author(s): 大関 武、大内 玲、相川 玄、小林 俊介、柴 優子、中島 久雄、松嶋 綾、櫻本 秀明
  • Organizer: 第15回日本クリティカルケア看護学会学術集会
• [Presentation] Association between fluid overload and delirium in mechanically ventilated patients (2018)
  • Author(s): Akira o,Yoshimi h, Haruhiko h, Hideaki S
  • Organizer: American Association of Critical Care Nureses
  • Int'l Joint Research
• [Presentation] 人工呼吸器患者における入室初日の体液バランス増加はせん妄発症と関連がある (2017)
  • Author(s): 大内 玲、櫻本 秀明、服部 温美、星野 晴彦、松田 武賢、相川 玄、岡本 麻由
  • Organizer: 第45回 日本集中治療医学会